Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling

Abstract

Aim This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder). Methods We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded. Results Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12‐month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments). Conclusion Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community‐based primary care, need to be explored to improve timely management.

Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and bladder problems

“…This includes more expensive services such as hospital outpatient and emergency departments 1,23 . For example, over a 3‐month period, 18.9% of children who presented to Victorian hospital outpatient clinics had been referred for a primary diagnosis of functional bowel and bladder problems 20 . The potential economic burden associated with hospitalisation 23 (e.g.…”

“…If the care that children can receive from primary care paediatricians in the USA is difference, then this supports our argument that Australian GPs skills in this area should be enhanced. Further, children referred to public outpatient clinics are often on wait lists for several months 19,20 . The implication is that the burden of care for these mostly straightforward but chronic paediatric conditions falls upon specialist paediatric services.…”

“…Further, children referred to public outpatient clinics are often on wait lists for several months. 19,20 The implication is that the burden of care for these mostly straightforward but chronic paediatric conditions falls upon specialist paediatric services. And the resultant question is, 'how efficiently is the GP gatekeeper-tospecialist-care function operating?'…”

Paediatric bladder dysfunction: A single centre experience of public hospital wait times

“…This audit reviewed outpatient clinic wait times and pathways for children with symptoms of bladder and/or bowel dysfunction (isolated bowel dysfunction, isolated wetting and mixed BBD) who had attended an appointment during April to June 2014. The 2014 audit was conducted in the same setting as the 2017/2018 review, with minor methodological differences in patient identification and screening . In 2014, patient records were manually screened to identify those who had been referred and seen for symptoms of wetting and/or bowel dysfunction.…”

“…In 2014, patient records were manually screened to identify those who had been referred and seen for symptoms of wetting and/or bowel dysfunction. A detailed methodology, selection criteria and findings from patients with isolated bowel dysfunction are provided in a related paper . For the purpose of this paper, we limited the data collected in 2014 to children aged ≥5 years and those experiencing symptoms of isolated wetting or mixed BBD.…”